About one of every five third-graders in Ohio had untreated dental disease in 2009-10, down from
one in four in 1998-99. • Despite that improvement, oral health remains the top unmet health need
for Ohio’s children and low-income adults, according to a report released in November by the Ohio
Department of Health and several partner organizations.

The Affordable Care Act was meant to address those needs by including pediatric dental care
among 10 “essential health benefits,” a set of services that must be covered by certain plans
beginning next month.

As a result of the law, as many as 8.7 million people younger than 21 are expected to gain
coverage nationwide by 2018, an analysis funded by the American Dental Association found. An
additional 17.7 million people who are at least

21 years old are expected to gain dental benefits, primarily through an expansion of Medicaid in
many states.

For those who don’t have health coverage through their job or Medicaid and instead buy it
directly from insurers, there are complications to keep in mind.

The law requires that pediatric dental benefits be offered through each state’s health-insurance
marketplace, where people can shop and compare health coverage. But there is no requirement that
consumers
purchase those pediatric dental benefits if they are offered as a stand-alone dental plan
and not as part of a medical plan.

In other words, dental benefits for kids that were intended to be mandatory in the marketplace
are, in fact, optional.

In Ohio’s federally run marketplace, some medical plans include dental benefits, particularly
for kids, but others don’t.

There’s another wrinkle: People who qualify for tax credits or cost-sharing subsidies that make
their medical coverage more affordable don’t receive such assistance for stand-alone dental plans.
What’s more, with stand-alone plans, there’s the potential for higher maximum out-of-pocket costs,
though the federal government has a plan to reduce the current maximum of $700 per child to
$300.

As a result, people who get dental coverage for their kids through stand-alone plans risk paying
more than those who get that coverage through subsidized medical plans.

The law appears to have created the potential of “an unintended imbalance,” said Meg Booth,
director of policy for the Children’s Dental Health Project, a Washington, D.C.-based nonprofit
group that works on access to pediatric dental care and prevention of dental disease.

Advocates of pediatric dental benefits say they weren’t intended to be offered separately in the
government-run marketplaces.

“We sometimes forget that our heads are attached to the rest of our bodies when it comes to the
health-care system,” said Sandy Oxley, CEO of Voices for Ohio’s Children and co-chairwoman of the
Children’s Oral Health Action Team in Ohio. She said mental-health benefits, like dental benefits,
traditionally have been treated as afterthoughts.

Though children of poor families in Ohio already have coverage through Medicaid, the state’s
pending expansion of the program bodes well for the oral health of kids.

“We know that the chances of children connecting to care increase 400 percent as their parents
gain coverage,” said Julie DiRossi-King of the Children’s Oral Health Action Team in Ohio.

Regardless of the law, Nationwide Children’s Hospital is planning to expand its dental clinics
to meet demand, said Dr. Paul Casamassimo, the hospital’s chief of dentistry.

The hospital is weighing several options, including adding a dental clinic at one of its
primary-care facilities, providing mobile dental services or establishing a presence in an
underserved area such as southeastern Ohio. A decision is expected in the next year or two,
Casamassimo said.

The hospital’s dental-clinic operations lost about $2.6 million in 2012, in part because
Medicaid reimbursement for dental services is low. Of the hospital’s dental-clinic patients, 73
percent are covered by Medicaid.